Frequently Asked Questions About Osteoarthritis
Treating Osteoarthritis
What medications are used to treat osteoarthritis?
There are no medications yet that treat the underlying disease process. Instead, the goal of medical treatment for OA is to ease pain and stiffness and make it easier to remain active.
The most commonly used medications for osteoarthritis are:
Analgesics – Analgesics are drugs that relieve pain. These medicines do not relieve inflammation or swelling. But if pain relief is your main concern, these drugs tend to have fewer side effects than drugs that relieve inflammation.
The most commonly used analgesic is acetaminophen, which the American College of Rheumatology recommends for the treatment of mild-to-moderate pain caused by osteoarthritis. Acetaminophen is available over the counter as generic and store brands or s the name brand Tylenol, Anacin (aspirin-free), Excedrin caplets and Panadol. Acetaminophen can be taken in doses of 325 to 1,000 mg every four to six hours, but no more than 4,000 mg should be taken per day. This drug can cause problems if used with alcohol. Check with your doctor before using acetaminophen if you consume more than three alcoholic drinks per day.
If you have severe pain, your doctor may prescribe a stronger analgesic. Examples include propoxyphene hydrochloride (Darvon, PC-Cap and Wygesic), acetaminophen with codeine and tramadol (Ultram). Often, these drugs are used only for short periods because the carry the risk of dependence.
Topical analgesics – These are creams, rubs and salves that are applied directly to the painful area. One of them, Voltaren Gel, is a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, and is available only by prescription. The rest are available over the counter. Their effects come from one or more of a variety of active ingredients. The most common ingredients are:
Capsaicin – A highly purified natural ingredient found in cayenne peppers, capsaicin works by depleting the amount of a neurotransmitter called substance P that is believed to send pain messages to the brain. For the first couple of weeks of use, the ingredient may cause burning or stinging. Capsaicin is available under the product names Zostrix, Zostrix HP, Capzasin-P and others. Menthacin includes both capsaicin and counterirritants.
Counterirritants – Like stepping on your toe to take your mind off a headache, counter-irritants stimulate or irritate the nerve endings to distract the brain’s attention from musculoskeletal pain. Counterirritants encompass such substances as menthol, oil of wintergreen, camphor, eucalyptus oil, turpentine oil, dihydrochloride and methlnicotinate and are found in products such as ArthriCare, Eucalyptamint, Icy Hot and Therapeutic Mineral Ice.
Salicylates – Like the salicylates found in many oral pain relievers, these compounds may work by inhibiting prostaglandins. They primarily work topically as counter-irritants, themselves stimulating or irritating nerve endings. Brand name examples of topical analgesics containing salicylates include Aspercreme, Ben-Gay, Flexall, Mobisyl and Sportscreme.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – Nonsteroidal anti-inflammatory drugs are a large group of medications used to help reduce joint pain, swelling and inflammation. NSAIDs are available over the counter and by prescription. For patients with knee osteoarthritis who experience moderate-to-severe pain and signs of inflammation, the American College of Rheumatology recommends NSAIDs as an alternate initial therapy to acetaminophen. Aspirin is the most common NSAID. Other examples of NSAIDs are ibuprofen (Advil, Motrin IB), ketoprofen (Actron, Orudis KT, Oruvail), naproxen (Naprosyn, Naprelan) and naproxen sodium (Anaprox, Aleve).
NSAIDs also include the class of drugs called COX-2 inhibitors, which are much like traditional NSAIDs but formulated to be safer for the stomach. At present, the only COX-2 inhibitor available is celecoxib (Celebrex). Two others were removed from the market when they were found to increase the risk of cardiovascular events.
NSAIDs work by stopping the production of chemicals called prostaglandins that occur naturally in the body and are involved in inflammation.
Corticosteroid injections – Corticosteroids are drugs related to the naturally occurring hormone in your body called cortisone. In some cases your doctor may inject these drugs into a painful joint for fast, targeted relief. When fluid builds up in an osteoarthritis knee, the doctor may drain fluid from the knee and then inject a corticosteroid medication. The American College of Rheumatology recommends corticosteroid injections as an alternate initial therapy for patients with moderate-to-severe knee pain and signs of inflammation who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint only three to four times per year.
Hyaluronic acid therapy –Hyaluronic acid is a substance naturally found in joint fluid that acts as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. By injecting it in the joint it may lessen pain and inflammation. The injections are given once a week for three or five weeks, depending on the product (examples are Synvisc and Hyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid.
According to ACR guidelines, Hyaluronic acid therapy may be helpful to patients who have inadequate response to NSAIDs or COX-2 drugs, or who have experienced adverse side effects from these drugs. Clinical trails have shown that the injections may provide pain relief for people with mild to moderate osteoarthritis of the knee. It is not know whether the injections are helpful for other joints.
What is an NSAID?
NSAID is an acronym for nonsteroidal anti-inflammatory drug. NSAIDs are among the most commonly used medications for osteoarthritis pain. In fact, they are among the most commonly used medications period.
NSAIDs are a large group of medications used to help reduce pain and inflammation. They include a number of over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB), ketoprofen (Actron, Orudis KT, Oruvail), naproxen (Naprosyn, Naprelan) and naproxen sodium (Anaprox, Aleve) as well as a dozen or so others available only by prescription.
NSAIDs work by stopping the production of chemicals called prostaglandins that occur naturally in the body and are involved in inflammation.
An important side effect to consider with NSAIDs is stomach upset and irritation, which can lead to stomach bleeding and ulcers. To guard against this problem, your doctor may recommend taking these drugs with food or taking a stomach-protecting drug with them. Another option is to take a COX-2 inhibitor. This is another type of NSAID, which is designed to be safer for the stomach.
Like traditional NSAIDs, COX-2s inhibit the production of prostaglandins, but they go about it a little differently. Research has shown that there are two types of enzymes involved in prostaglandin production. One type, known as COX-1, produces prostaglandins that help protect the digestive system from its own corrosive acid. The other type, called COX-2, is involved in the production of prostaglandins that play a role in inflammation. Traditional NSAIDs inhibit both COX-1 and COX-2, which decreases inflammation but can cause damage to the stomach. Instead of affecting all prostaglandins, COX-2 drugs only stop production of the type of prostaglandin involved in inflammation, without affecting those that protect the stomach (controlled by COX-1).
In theory, because they don’t affect the stomach-protecting prostaglandins, the COX-2 drugs should be safer for the stomach than typical NSAIDs. However, they carry a risk of heart attack, stroke, blood clot or severe skin reactions. At present, the only COX-2 inhibitor on the market is celecoxib (Celebrex). Two others were voluntarily pulled from the market because of the risks.
Will I need surgery?
Most people with osteoarthritis will never need surgery, but if you have severe joint damage, extreme pain that isn’t helped by other treatments, or very limited motion as a result of osteoarthritis, surgery may be necessary.
Surgical procedures can provide several benefits, including the following:
Improved movement – If the constant wearing away of cartilage makes it difficult for you to move, making it difficult to your to get around and stay independent, replacing the damaged joint with a synthetic one can make it easier for you to move and continue activities that you enjoy.
Pain relief – If osteoarthritis causes severe, constant pain that isn’t relieved by treatments such as medications, exercise or physical therapy, surgically replacing the painful joint or removing loose growths that are causing pain, for example, can relieve pain.
Improved joint alignment – In some cases, osteoarthritis can cause the joint to become maligned so that it no longer functions as it should and it looks unusual. In the knees, surgery can correct or improve this misalignment. But appearance should not be the main reason for having surgery; improved appearance should be a bonus of surgery that is preformed to improve movement and relieve pain.
Non-Drug Treatments to Ease Osteoarthritis Pain
Are there any “natural” supplements that can treat osteoarthritis?
Do glucosamine and chondroitin work?
What other treatments can ease osteoarthritis pain?
Taking Control of Osteoarthritis
Should I exercise with osteoarthritis?
Does stress affect osteoarthritis?
If osteoarthritis runs in my family, is there anything I can do to keep from getting it, too?
About Osteoarthritis
What are the symptoms of osteoarthritis?
Getting Diagnosed
How is osteoarthritis diagnosed?
Back to Focus on OA
